关节镜下打结技术 .ppt

Arthroscopic knot typing a instruction Manual The Department of Trauma and Hand Surgery The First Affiliated Hospital of university of Guangxi Traditional Chinese Medicine An increasing number of surgeons are performing arthroscopic surgery in the knee to repair meniscal tears and in the shoulder to repair rotator cuff or labral tears Many are also performing capsular shifts to treat instability. Essential to these procedures is the ability to tie arthroscopic knots to approximate intraarticular Introduction The surgeon must sequentially construct the knot outside the joint and then pass the knot into the joint through small cannulas Tying arthroscopic knots is technically demanding and requires considerable practice With the popularity of arthroscopic surgery, the number of used arthroscopic knots and the number of surgeons using these knots has increased Knot Tying Principles The goal of knot tying is to approximate tissue under tension and maintain the tissue in apposition until biologic repair and healing can occur It is imperative for all surgeons to learn and use knot-tying techniques that minimize the chance of knot failure Knot security friction, internal interference, and slack between throws Friction is inherent to the suture material Internal interference the configuration of the knot and increased by the length of the contact between the loop limb and the post limb slack between the individual throws in each knot to maximize loop security slippage can lead to failure of tissue apposition Knot Tying Principles four different processes of knot failure knot slippage and loosening suture breakage tissue failure suture anchor pullout from bone through suture breakage Knot failure Knot Terminology post limb (also commonly known as the axial limb) loop limb (also commonly known as the wrapping limb, working end, running end, or free end) Knots are constructed by tying the loop limb around the post limb (Fig. 1) FIGURE 1. Loop and post configuration